Russian Medical Reports Mysteries
Frequently prospective adoptive parents (and their advising physicians) are amazed with Russian medical report. I have seen medical reports that when translated into American medical terminology almost describes a devastated child. This information seems to conflict with what the adoption agency reported to the parents and even conflicts with the recent video tapes provided and even with personal contact that the parent may have had with the child when visiting the orphanage.
I recall my first International adoption consultation which is where I became interested in this field. A very nice adoptive mother approached me in my private general Pediatric practice and had asked me to evaluate her sons medical chart. The medical record was properly translated into legible English. After reading it, I was heartbroken when I realized that from my interpretation of this Childs past medical history, it appears that this child may suffer from cerebral palsy. I subsequently reviewed the videos and pictures provided. To my astonishment, this child was in very good health. He had no facial characteristics or motor deficits as I expected from the record. I mentioned these conflicting issues with the record.
I am happy to say that this mother adopted Christian and he is now 6 years old, in first grade and doing perfectly well. He was one of the lucky ones. I receive great joy when I see Christian for routine check-ups and find nothing wrong with him.
Why Russian medical reports are the way they are ?
It is sometimes said that diagnoses are exaggerated because only unhealthy children may be adopted or to increase the funding available to the orphanage. By giving them a diagnosis, it places these children in a special needs category thus making them legally adoptable.
The following list is common diagnosis found on Russian Medical reports :
1) Abnormal chordae (trabeculae):
Extra muscle tissue in the wall of the heart, sually the left ventricle This feature is found with the help of an echocardiogram of the heart.
This is an “incidental finding;* it does not cause any symptoms or medical disease.
2) Intestinal Dysbacteriosis:
Loose or diarrheal stool following lack of breast-feeding, illness or a course of antibiotics. This occurs secondary to changes in the normal bacterial flora of the intestine. Treated first with an antibiotic to decontaminate the gastrointestinal tract and then with “ferments and enzymes,” similar to our treatment with lactase (milk sugar enzyme) or lactobacillus.
3) Hyperexcitability (neuro-excitability, neuro-reflex irritability) syndrome:
Similar to muscular dystonia but diagnosed within the first 3 months of life. Noted when the infant has marked reactions to” stimuli (such as being moved or disturbed), especially if tremor, increased newborn reflexes, trembling chin or frequent belching is present. It may result in movement disorder at an older age. In the U.S.A we do not make mention of this and just state that they are normal newborn reflexes.
4) Hypertension- hydrocephalic syndrome:
Clinical diagnosis based on one or more criteria alone or in combination:
- increased muscle tone brisk reflexes
- firm or tease fontanel (soft spot)
- pulsation of me fontanel
- large head circumference
- dilated blood vessels over the scalp
- prominent or bulging eyes
- “sundowning” of the eyes
- bluish discoloration over the bridge of the nose.
May be confirmed by ultrasound of the brain looking for dilation of the ventricles medical pathology occurs when these ventricles become enlarged because of accumulation of this fluid in the brain, thus causing a very large head. Considered in most children to be a transient condition secondary to the birth process. Treated with certain vitamins, diuretics, and/or other drugs to improve blood flow to the brain. Surgical shunting is very rare, but if it is required then true brain pathology exists.. The condition is considered to be “subcompensated” when the child still has some minor signs or symptoms but is doing okay. It is “compensated”. when there are no clinical signs except perhaps for a head slightly out of proportion with the rest of the body, at this point the child expected to be normal.
Short stature or growth delay without any other medical problems, usually genetic or “constitutional.” Also used to refer to under-development of any organ such as a limb, the testis, an eye, etc
Weight lower than expected for age. May be further described as mesosomatic or microsomatic, harmonious or dysharmonious, depending on changes from previous growth and the relationship to the height and chest circumference.
7) Hypoxia of the newborn: Lack of oxygen at or before de
livery, usually diagnosed if it was a difficult pregnancy, labor or delivery, if the baby needed resuscitation at birth or if there was any specific abnormalities are noted in the placenta or afterbirth. When severe oxygen deprivation occurred, words like “asphyxia” are used. “Prenatal hypoxia” is a vague term, sometimes linked with the wording “non-specific intrauterine infection” to explain away low weight or asymmetric reflexes or tone in a full term baby.
8) Hypoxic (metabolic) cardiopathy:
A clinical diagnosis, sometimes confirmed by “metabolic, changes in the EKG.” This refers to any number of mild changes in circulation such as perioral cyanosis (blueness around the laps or nose), irregular heartbeat, mottled skin, anemia or rickets. This is a transient condition which resolves when me underlying condition is treated. Term may be used for more serious conditions such as myocarditis or infection of the heart.
9) Increased seizure readiness syndrome:
When a child has an evaluation for suspected seizures or some other problem, an EEG of the brain may be done. The term is used to describe the finding of an abnormal focus on the EEG or when a child has increased muscle tone not related to cerebral palsy. Usually no treatment is given.
10) Minimal brain dysfunction:
Used variably to describe transient neurologic conditions such as abnormalities in the reflexes or “soft” neurologic signs such as hyperactivity or short attention span. It may mean what we in the USA diagnose as ADHD. If there are any suspicious facial features of fetal alcohol syndrome, this associated diagnosis will make FAS more likely.
11) Movement (motor) disorder:
This is a result of muscular dystonia, usually manifested as a delay in gross motor skills. For example, a 10 month old who cannot crawl has a movement disorder. This is not considered a serious diagnosis in contrast to more severe forms, pyramidal insufficiency or spastic tetraparesis. This is a diagnosis that is used when a child is not “perfect” but no other diagnosis can be made. Mild developmental delay.
12) Muscular dystonia:
Muscle tone is considered to be dependent on the emotional condition of the baby. A normal child should be calm with appropriate relaxed tone. Muscular dystonia is present when the tone is very high (jittery or irritable) or is labile (changes rapidly). This is not a permanent condition but changes over brief time periods (an hour) as the baby’s state changes (from sleepy to alert, etc.)
Functional mental impairment, meaning the person is not operating at the expected intellectual level, this is usually not diagnosed until older than 4 years. It may be caused by many different conditions such as genetic disease, head trauma, infection, etc. Ranges from mild mental delay to severe mental retardation. Unfortunately, it spans from minimal learning disability to severe mental retardation.
14) Perinatal (prenatal) encephalopathy:
(Variably translated “perinatal lesion or affectation of the central nervous system,” “encephalopathia,” and many others.) This is a diagnosis that is given to a newborn when one or more risk factors are present. Either in the medical history of the mother or in the baby which may allow for a poor neurological outcome, but this does not necessarily mean that every baby will have a poor outcome. It is similar to the rule out diagnosis that we make in the USA.
15) Prematurity Classification:
Determined by maternal history and/or a scoring system such as the Dubowitz (same as used in North America). Described as stage or degree
Stage or degree Gestational Age Weight
1 36-37 weeks 2001-2500 grams
2 32-35 weeks 1501-2000 grains
3 28-31 weeks 1000-1500 grams
4 < 28 weeks < 1000 grams
16) Psycho-affective respiratory attack:
Breath-holding spells. These are of no medical consequence. If one was to go to a Toys R US in the USA, just look at the child who did not get the toy that he wanted. He screams and cries until he turns blue and then he passes out for a second or two. Parents fear that they were having a seizure, but they actually were not.
17) Pyramidal insufficiency.:
Infant considered to be at risk of cerebral palsy because of adverse perinatal history (eg, extreme prematurity or low birth weight) and/or because of abnormal physical examination (eg, increased tone or reflexes, asymmetry of reflexes, delayed development). Usually cannot be confirmed as cerebral palsy until after 12 months of age as some children win improve before then. Usually is apparent by 6 months of age and, if it is going to resolve, disappears by 1 year.
Rickets, bone disease due to lack of vitamin D. Stage or degree Time to develop. Clinical signs 1 Weeks Minimal or nothing at all. 2 2-3 months Delayed development due to bone pain and weakness 3 Many months Marked developmental delay, bone deformation, abnormal skull shape or size, poor muscle tone an strength.
19) Spastic tetraparesis:
This is a more serious form movement disorder in children less than 12 months of age graded from mild to severe, involving all 4 limbs. In worst case, the child barely moves at alt. If treatment (massage and physical therapy) is started early, this usually easily correctable but some children have persistent neurological findings. If one is to see this diagnosis on the record you should be very suspicious of cerebral palsy. This is where the video is important.
20) Stage of condition: The progression of a disease:
A) Recuperation or rehabilitation: Improving but still requiring treatment.
B) Residual: Almost recovered but signs or symptoms not completely resolved, expected to be healthy. Also used for late or ermanent results such as scar or stroke.
C) Recovery Condition: illness completely resolved.
D) Compensated : Abnormal but stable.
E) Subcompensated: Abnormal, clinically unstable, may deteriorate.
Perintal (prenatal) encephalopathy:
- Lack of known medical history
- Drug, alcohol or cigarette use
- No prenatal care
- Past miscarriages, abortions or premature deliveries
- Young or old maternal age
- High number pregnancy
- Chronic health problems
- Poor social situation
- Difficult or complicated delivery
- Abnormal placentaInfant factors:
- Low Apgar scores
- Abnormal muscle tone or reflexes
- Irritability or depression
- Poor suck, feeding problems
- Abnormal head circumference
- Congenital abnormalities
- Genetic conditions
- Abnormal ultrasound of brain or other parts of body
- Intrauterine or perinatal infections
- Abnormal prenatal growth
- Abnormal laboratory tests